Policy WHS-PRO-023 Infection Control Procedure

WHS-PRO-023 Infection Control Procedure


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Intent

JCU is committed to minimising the risk of exposure to infectious diseases which may affect students, staff and other individuals while undertaking JCU authorised activities.

This procedure articulates the requirements for immunisation, screening, infection control practices and management of pandemics or disease outbreaks in order to minimise the risk of exposure to infectious diseases and fulfil JCU’s obligation to provide a healthy and safe environment.

In committing to the responsibilities under this procedure, JCU remains committed to all relevant laws, legislation and University policies, including those providing for a work, study or research environment free from discrimination.

Scope

This Procedure applies to all JCU staff, students, (both domestic and international) and contractors. Visitors and volunteers will be jointly referred to as “others” (as the context requires).

In addition, this Procedure applies to all JCU authorised activities that may include but are not limited to teaching, research, placements, field trips (both domestic and international).

JCU Controlled Entities and related bodies corporate are required to meet the obligations of the relevant legislation, regulations and codes of practice related to infectious disease for its operations.  JCU Controlled Entities are not required to comply specifically with this Procedure.

JCU staff, students and others will be required to comply with the Procedures of other organisations while conducting JCU authorised activities (for example during placements in a healthcare setting).

This Procedure operates in conjunction with the HSE-PRO-009 Biosafety Procedure.  The Biosafety Procedure includes requirements for physical containment facilities and the biosafety application process.

Definitions

Term

Definition

Infectious Disease

Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; infectious diseases can be spread, directly or indirectly, from one person to another.  Examples include strep throat, tuberculosis and the common cold

Blood-Borne Virus (BBV)

A disease that can be spread through contamination by blood and other body fluids.  Blood-borne pathogens are microorganisms such as viruses or bacteria.  Examples include Hepatitis B and HIV.

Exposure Prone Procedure

(EPP)

Invasive Procedures where there is potential for direct contact between the skin, usually finger or thumb of the healthcare worker and sharp surgical instruments, needles, or sharp tissue, splinters of bone or teeth in body cavities or in poorly visualised or confined body sites, for example the mouth of the patient.  Examples including dentist placing fingers into the mouth of a patient

Zoonotic Infection

Zoonosis are infectious diseases that can be transmitted between animals and humans.  Zoonosis can be caused by a range of disease pathogens including viruses, bacteria, fungi and parasites.  Examples include Anthrax, Salmonella, and Q Fever

Bacillus Calmette-Guerin (BCG) Vaccine

A vaccine primarily used against tuberculosis (TB).

dTPa / DTPa

(has pertussis)

Refers to a vaccine that is at concentrations for an adult.  DTPa is a formulation with lesser quantities intended for children

is the acronym for the triple antigen vaccine, combined diphtheria –tetanus- acellular pertussis vaccine formulated for adolescents and adults

Standard Precautions

Work practices are required to achieve a basic level of infection control, they include hand hygiene and cough etiquette; the use of personal protective equipment (PPE), the safe use and disposal of sharps; routine environmental cleaning and the incorporation of safe practices for handling blood, body fluids and secretions as well as excretions.

Student Supervisor

The member of staff that is supervising a research student

Field Trip Leader

The person authorised by the Director / Dean to lead the field trip, and who is responsible for the health and safety for all persons attending for the duration of the field trip.

Table of Contents

1        Duty Obligations and Responsibilities. 3

1.1         Vice Chancellor 3

1.2         Deputy Vice Chancellor / Director of Operations / College Manager / Directors / Deans / Health of Discipline / Managers. 3

1.3         HSE Unit 3

1.4         Staff / Students / Others. 3

2        Requirements. 3

2.1         Confidentiality & Information Privacy. 3

2.2         Discrimination. 3

2.3         Immunisation. 4

2.4         Infectious Disease Screening. 9

2.5         Acute Infections and Medical Exclusion. 12

2.6         Pregnancy and Immunocompromised. 14

2.7         Health Screening. 15

2.8         Instance of Exposure to Infectious Disease. 15

2.9         Infection Control 17

3.0         Sharps and Clinical Waste. 19

3.1     Notifiable Disease Reporting. 19

3.2         Outbreak Investigation & Management & Notifiable Disease. 20

4        Related Documents, Legislation and Other Resources. 22

4.1         Regulatory Authorities and Other Relevant Entities. 22

4.2         Related Legislation, Codes of Practice and Standards. 22

4.3         Related Documents and Other Resources. 22

5        Schedules/Appendices. 22

6        Administration. 23

1      Duties, Obligations and Responsibilities

1.1 Vice Chancellor

  • The Vice Chancellor has responsibility to ensure the University is compliant with this procedure

1.2    Deputy Vice Chancellor / Director of Operations / College Managers / Directors / Deans / Head of Discipline / Managers

  • To ensure the obligations of this procedure are complied with
  • To provide the information requested as outlined in the procedures, and in the format required by the HSE Unit, by the due date each year.

1.3 HSE Unit

  • Consolidate information submitted by the Divisions into the relevant format

1.4 Staff / Students / Others

  • To comply with obligations of this procedure
  • Notify supervisors if any condition arises that could place the person at risk such as immune suppressed.

2      Requirements

The requirements of this Procedure are aimed at minimising the risk of infectious diseases.  This Procedure is to be read in conjunction with all relevant guidelines, codes and information issued by professional bodies and Australian health departments.

2.1 Confidentiality and Information Privacy

Staff, students and others have a right to strict confidentiality of information obtained or held in relation to infection status and / or medical records.  The relevant JCU Divisions must ensure that information gathered throughout this process is collected, stored, managed and disclosed (if necessary) in accordance with the requirements of the Information Privacy Act 2009 (QLD).  JCU’s information privacy related policies and Procedures (as amended from time to time) specify the right of access to, and amendment of personal information collected by JCU.

2.2    Discrimination

Staff, students and others who have or acquire a Blood Borne Virus BBV (or any other infectious disease) will not be subjected to any form of unlawful discrimination by JCU.  JCU is committed to providing a discrimination free environment for its staff, students and others.

2.3    Immunisation

Divisional staff must consult with the Colleges and Institutes to determine whether activities conducted by JCU staff, students or others require immunisation due to the potential for exposure to vaccine preventable infectious diseases.  This information must be sent annually to the Health Safety and Environment (HSE) unit before the start of Semester 1.

Staff, students and others participating in the listed activities are required to be immunised as a precaution against exposure to infectious diseases.  The listed activities and immunisations required by JCU will be consistent with information contained in the current edition of The Australian Immunisation Handbook, which may be updated from time to time.

Tracking of the immunisation status of staff, students and others will remain the responsibility of each Division.

Immunisation is used as a standard precaution for the occupation/activities identified in Table 1, which has been extracted from The Australian Immunisation Handbook 10th Edition.

Table 1: Examples of Occupations and Immunisations

Occupation/Activity

Immunisation

All healthcare workers (HCW) includes all workers and students directly involved in patient care, conduct exposure prone Procedures or the handling of human tissue, blood or body fluids

  • Hepatitis B
  • Influenza
  • Measles, Mumps and Rubella   (MMR)
  • Pertussis (dTpa)
    Varicella

Healthcare workers who work in remote indigenous communities or with indigenous children in NT, Qld, SA and WA, and other specified healthcare workers in some jurisdictions

  • Immunisation listed for ‘All   HCW’, plus Hepatitis A

Healthcare workers who may be at high risk of exposure to drug-resistant cases of tuberculosis (dependent on state or territory guidelines)

  • Include the vaccines listed   for ‘All healthcare workers in this table,
  • Also consider Bacillus  Calmette-Guerin (BCG) (Tuberculosis   Immunisation)

All persons working with children, including but not limited to:

  • Staff and students working in   early childhood education and care
  • Correctional staff working   where infants/children cohabitate with mothers
  • School teachers (including   student teachers)
    and outside school hours carers
  • Child counselling services   workers
  • Youth services workers
  • Influenza
  • MMR (if non-immune)
  • Pertussis (dTpa)
  • Varicella (if non-immune)
  • Include Hepatitis A if   working in early childhood education and care
  • Influenza
  • MMR (if non-immune)
  • Pertussis (dTpa)
  • Varicella (if non-immune)
  • Include Hepatitis A if working in early childhood education and care

Staff and students working in nursing homes and long-term care facilities for persons of any age

  • Hepatitis A
  • Hepatitis B
  • Influenza

Laboratory personnel handling veterinary specimens or working with Q fever organism (Coxiella burnetii)

  • Q fever
  • Tetanus

Laboratory or field personnel handling either bats, bat tissues or lyssaviruses (including rabies virus and Australian bat lyssavirus)

  • Rabies

Laboratory personnel handling human diagnostic specimens

  • Hepatitis A
  • Hepatitis B

Laboratory personnel routinely working with these organisms:

  • Bacillus Anthracis
  • Vaccinia Poxviruses
  • Poliomyelitis virus
  • Salmonella enterica   subspecies enterica serovar Typhi (S. Typhi)
  • Yellow Fever virus
  • Neisseria Meningitides
  • Japanese Encephalitis virus
  • Cholera toxin
  • Diptheria toxin
  • Anthrax
  • Smallpox
  • Poliomyelitis (IPV)
    Typhoid
  • Yellow fever
  • Quadrivalent
    meningococcal conjugate vaccine (4vMenCV)
  • Meningococcal B (MenBV)
  • Japanese Encephalitis
  • ADT vaccine

Workers who live with, or make frequent visits to, remote indigenous communities in NT, Qld, SA and WA

  • Hepatitis A

Workers assigned to the outer Torres Strait Islands for a total of 30 days or more during the wet season

  • Japanese Encephalitis

Veterinarians, veterinary students, veterinary nurses

  • Influenza
  • Q fever
  • Rabies
  • Tetanus

Agricultural college staff and students (aged >15 years) exposed to high-risk animals

  • Q fever

Staff conducting occupations similar to:

  • Abattoir workers and contract   workers in abattoirs (excluding pig abattoirs)
  • Livestock transporters
  • Sheep shearers and cattle,   sheep and dairy farmers
  • Those culling or processing   kangaroos or camels
  • Tanning and hide workers
  • Goat farmers
  • Livestock saleyard workers
  • Those handling animal   products of conception
  • Q fever

Wildlife and zoo workers who have contact with at risk animals, including kangaroos and bandicoots

  • Q fever

Persons who come into regular contact with bats (both ‘flying foxes’ and microbats); bat handlers; bat scientists; wildlife officers; zoo curators

  • Rabies

Poultry workers and others handling poultry, including those who may be involved in culling during an outbreak of avian influenza, and swine industry workers

  • Influenza

Embalmers

  • Hepatitis B

Funeral workers and other workers who have regular contact with human tissue, blood or body fluids and/or used needles or syringes

  • Hepatitis B

Plumbers or other workers in regular contact with untreated sewage

  • Hepatitis A
  • Tetanus (dT or dTpa)

2.3.1   Teaching and Research at JCU Facilities

Immunisation requirements are dependent on the potential exposures that could occur over the course of study, research, use of facilities, travel to other locations and activities conducted by the staff that provide support functions throughout JCU.  The requirements of this section of the procedure aim to ensure that potential exposures are considered for teaching, research, or other specific facility requirements.

Teaching:

  • Divisions are required to annually provide a consolidated list of courses and subjects that require participants to adhere to the required immunisation schedule.  The listing is to be provided to the HSE unit before the start of Semester 1 of every year.  The consolidated list for JCU will be provided on the JCU website;
  • Students who perform exposure prone Procedures must undergo testing for BBV and be immunised against any blood-borne virus which has a commercially available vaccine as per Table 1;
  • Students must be made aware of this Procedure and the immunisation requirements and infectious screening (see section 5.4 of this Procedure) requirements of their course of study;
  • Divisions must confirm that any required vaccination has occurred prior to any potential exposure;
  • The immunisation list will need to identify the specific roles that require the adherence to this Procedure;
  • The list must include immunisation(s) that are required for placement.  For example:  to enter Queensland Health facilities, or travel overseas; and where this information can be sourced.

Research Project:

This category covers staff within the (Division/college):

  • Any immunisation requirements that are required before the use of particular facilities must be adhered with and in the form provided.
  • Any immunisation requirements that are required before the use of particular facilities must be adhered with and in the form set out in the Facility Immunisation List.  For example: the BCG vaccination is required before entry into the JCU Building 48 PC3 laboratory is permitted;
  • During the planning for a research project, potential for exposure to infectious diseases must be documented in the risk assessment and biosafety application.  This may be due to, amongst other things:
    • Facilities used at JCU or facilities other than at JCU;
    • The materials that will be used and potential interactions with infection sources including potential for Blood Borne Viruses and Zoonotic infection;
    • Requirements of other facilities such as Queensland Health facilities, or abattoirs;
    • Specific risk of the project such as handling of bats, or visiting countries with diseases that are endemic that do not exist in Australia such as rabies.
  • Where there is potential for exposure to infectious disease identified, a biosafety application will be required.  The process for biosafety applications is found in the HSE-PRO-009: Biosafety Procedure.

Facilities:

A consolidated list must be maintained of JCU facilities that require immunisations.

  • The Divisions are required to annually provide a list of facilities that require immunisation to gain entry.  This listing is to be provided to the HSE unit.  This consolidated list will be presented on the JCU website;
  • The Divisions are required to annually provide a list of facilities that require immunisation to gain entry.  This listing is to be provided to the HSE unit.  This consolidated list will be presented in the Facility Immunisation List;
    • It must include the risks, any baseline antibody tests or health monitoring that is required, immunisation and the types of roles that require the immunisation such as students, college, or Estate Directorate staff;
  • The Division must ensure that staff, students and others are made aware of the immunisation requirements for the relevant facilities, and that the required vaccinations have been completed.

2.3.2   Service Units

Divisions are required to identify roles that may require immunisation due to the particular duties of its staff members:

  • The Divisions are required to annually provide a list of roles that require immunisations.  The list is to be provided to the HSE unit prior to the start of Semester 1 each year.  The consolidated list will be in the form provided’.  These are roles that are not captured in section 5.3.1.  For example:
    • Groundskeepers requiring Q fever vaccination due to risk of kangaroo faeces on lawns;
    • Support staff that maintain facilities with immunisation requirements;
    • All staff that have potential to contact blood or bodily fluids;
    • Staff working with infectious agents in laboratories.

2.3.3   Professional Experience Placement at Non JCU Facilities

Divisions are required to provide a list of known placement immunisation requirements.  The listing is to be provided to the HSE unit before the start of Semester 1 each year.

The requirements of host organisations must be adhered to where immunisations requirements have been put in place by the host organisations.

  • An assessment of any immunisation requirements for placements will need to be conducted by the relevant Student Supervisor / Course Placement Coordinators;
  • The divisions are required to annually provide a list of placements that require immunisation.  The listing is to be provided the HSE unit before the start of Semester 1 each year.  In addition to any and all requirements of JCU.  The consolidated list will be presented in on the JCU website;
  • Under the Public Health Act 2005 (Qld), healthcare facilities are required to have an Infection Control Management Plan (ICMP) in place.  The ICMP should state the immunisations that are required.

2.3.4   Field Trips, Overseas Placement or Study

As part of the field trip risk assessment (HSE-PRO-007 Field Trip Procedure) the potential for exposure to infectious disease must be considered as part of the planning of field trips by the Field Trip Leader.

If it is advised (e.g. Department of Foreign Affairs) that staff and students should seek further immunisations prior to travel, a General Practitioner (GP) should be consulted with advice sought in respect of the planning for overseas trips.  The participant must provide the GP with the following information, without limitation:

  • Travel itinerary;
  • Activities that may place the person at risk (for example: collecting clinical samples);
  • Any personal health issues, such as pregnancy or immunosuppression.

2.3.5   Immunisation Refusal, Contraindication & Vaccine Non Response

There are cases where immunisation may not be effective or possible.  This includes, without limitation:

  • Refusal to undergo immunisation;
  • Where there is medical advice that the immunisation may have a contraindication (such as anaphylaxis) or is not recommended (for example: pregnancy) and the person cannot be immunised; or
  • Non response to an immunisation, where the relevant immune function does not occur.

In these cases the Head of Discipline must conduct individual assessment for staff and the course coordinator for students.  The person must have an assessment and plan developed to determine the following:

  • If the person can continue the course of study or in the role they were appointed;
  • Suitability for role/duties or course of study.  While being non immunised may not totally exclude a person from activities, alternate activities will need to be found in order to control the risk to both the person and anyone else that can be placed at risk to non-immunisation (such as in primary treatment of patients);
  • Students who are enrolled in an accredited course that has a Professional Experience Placement as part of their course requirement, must meet all of the immunisation and testing requirements of their specific course. If a student is unable to meet the immunisation requirements of their course they must discuss this with the Course Coordinator prior to census date of the current teaching period.

JCU may, in its absolute discretion, determine that a person cannot participate in a particular activity if that person has refused the required immunisations, where the immunisation may have a contraindication and / or where a non-response to the immunisation may occur.  JCU may choose to, but is not obligated to, seek independent medical advice in making its decision.

The documented management plan of these cases must be approved by the Head of Discipline for staff and by the course coordinator for students.  In other cases the supervisor of the staff member is required to document the plan.

2.3.6   Contractors, Volunteers & Visitors

Contractors, volunteers and visitors are required to have completed the relevant immunisations before conducting activities or entering facilities.  The relevant immunisations will depend on the nature of the contractor’s work, for example:

  • Contract lecturer running a practical will need to comply with the requirements listed for the subject and/or facility;
  • Contract electrician conducting maintenance activities at JCU facilities will need to comply with the requirements listed for the facility to be visited.

If there will be variation from this requirement, a risk assessment must be conducted.  The risk assessment must have sufficient control(s) in place to reduce the risk to as low as reasonably practicable.

The risk assessment must be approved by Head of Discipline or supervisor that is in control of the facility.

2.3.7   Cost of Immunisation

Students:

  • Where it is identified that students require immunisation for their course of study the student will be responsible for the costs of such immunisation;
  • In regard to research students, allowances may be made for payment of particularly expensive or novel vaccines if prior approval of the student supervisor is first received.

Staff:

  • Where immunisation is identified to be required for staff members the cost of the immunisation will be covered by the unit of employment.

Contractor, Volunteers & Visitor:

  • Contractors, volunteers and visitors are responsible for the cost of their own immunisations.

2.4     Infectious Disease Screening

There are instances where staff, students and others are required to undergo screening for infectious diseases.  This is to protect patients/clients that may be exposed to disease through medical care and Procedures.  There are instances in the healthcare sector that require a person that conducts activities identified in Category A in Table 2 undertake infectious disease screening and must provide evidence that they do not have the infectious diseases identified.

The infectious diseases that are typically included in screening are Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) (where immunity is demonstrated testing is not carried out for HBV) and Hepatitis C Virus (HCV).  Other testing may be required from time to time.

Table 2 is taken from Australian Guidelines for the Prevention and Control of Infection in Healthcare.

2.4.1  Table 2: Healthcare Infectious Disease Screening

Category

Risk

Examples

A

Direct contact with blood or body substances:

  • This category includes all   persons who have physical contact with, or potential exposure to, blood or   body substances.

Dentists; medical practitioners; nurses; allied health practitioners; healthcare students; laboratory staff; maintenance engineers who service equipment; sterilising service staff; cleaners; and staff responsible for the decontamination and disposal of contaminated materials.

B

Indirect contact with blood and body substances:

  • Rarely have direct contact with blood or body substances;
  • These employees may be exposed to infections spread by airborne or   droplet routes, but are unlikely to be at occupational risk from blood-borne   diseases.

Catering staff and ward clerks.

C

Minimal patient contact:

  • Occupational groups that have no greater exposure to infectious   diseases than do the general public;
  • The exact nature of job responsibilities should be taken into   account when deciding immunisation requirements, and all staff should be   encouraged to be fully vaccinated.

Office clerical staff, gardening staff and kitchen staff.

Laboratory and Research Staff

If direct contact with blood or body substances from humans:

  • May have additional   vaccination requirements if they are working with or may be exposed to   specific agents, e.g. Q fever, anthrax, poliomyelitis, Japanese encephalitis;
  • Diphtheria toxin.

Research with tuberculosis;

Research with diphtheria toxin receptor mice.

The Divisions must provide a list of courses where staff, students, contractors, volunteers and visitors are required to undertake infectious disease screening and identify the specific diseases to be tested (such as HIV, HBV, and HCV).  The listing is to be provided to the HSE unit before the start of Semester 1 each year. The consolidated list will be provided on the JCU website.

The Divisions must have proper systems and processes in place to ensure that infectious disease screening is occurring, as and when required.

2.4.2   Students

During the enrolment process students enrolled in a course that requires screening are to be made aware that they are required to undergo screening for HIV, HBV and HCV (or other relevant infectious disease).

  • The results of any screening test must be kept strictly confidential;
  • Counselling must be provided to students that return a positive result;
  • When a positive test is returned, an assessment of the student’s ability to continue the course of study will need to be determined with the relevant college;
    • The student will no longer be able to conduct any exposure prone Procedures.
  • Students must arrange screening and provide evidence that screening has been conducted.  The Divisions must have proper systems and processes in place to ensure that this process is occurring, as and when required;
    • The cost of this screening is to be borne by the student.
  • Students have an ethical obligation to seek screening if they believe they have been at an increased risk of exposure to infectious disease.

2.4.3   Staff and Colleges

Members of staff and colleges that are required to undergo blood born virus screening (HIV, HBV or HCV, or other disease as required) are to be made aware that they are required to undergo screening.

  • The results of any screening test must  be kept strictly confidential
  • Counselling must be provided for staff that return a positive result
  • Staff also have an ethical obligation to seek screening if they believe they have been at an increased risk of exposure to infectious disease.
  • When a positive test is returned, an assessment of the staff member’s ability to conduct activities within the course of study or research will need to be determined with the relevant College
    • In particular the person will no longer be able to conduct any exposure prone Procedures
    • Redeployment or alternative duties will be considered
  • The Divisions must have proper systems and processes in place to ensure that this process is occurring, as and when required.  The Division will need to retain evidence that this screening has been conducted
    • The cost of this screening is to be borne by JCU.

2.4.4   Human Anatomy Donations

There is a potential risk of exposure to blood-borne viruses during the collection and treatment of donor bodies. JCU will conduct screening tests for HIV, Hepatitis B, and Hepatitis C.  The Anatomy Laboratory will have localised procedures for the management of this process.  The procedures will include:

  • Obtaining consent for testing, including the next of kin to be contacted in the event of a positive test
  • If the screening test is negative for HIV, Hepatitis B and Hepatitis C then the donor body will be accepted.  If the screening test is positive for HIV, Hepatitis B or Hepatitis C the body will not be accepted into the program;
  • All records are to remain confidential.

2.4.5   Donation of Horses to JCU (Hendra)

Horses that are donated to the JCU veterinary program have potential for infection with Hendra Virus.  This has resulted in JCU putting in place the following conditions:

  • All JCU owned horses are Hendra vaccinated;
  • The JCU veterinary program has a Procedure in place for Hendra screening and immunisation of all donor horses.  This includes:
    • Live horses donated to be used in practical sessions;
    • Live horses used on JCU properties (for example: Fletcher view);
    • Live horses donated to be euthanized for necropsy purposes.

If a horse housed at JCU facilities is suspected of having Hendra the animal is to be quarantined and diagnostic testing carried out immediately.  See section 5.12 of this Procedure in regard to escalation of suspected and confirmed cases of Hendra.

2.5    Acute Infections and Medical Exclusion

Any member of staff with an infectious disease listed in Table 3 below (exclusions may occur for other infectious diseases based on medical advice) is responsible for the following:

  • Must consult with an appropriate, licenced medical practitioner to determine whether or not they are capable of conducting their duties and attending the workplace without infecting other people;
  • If requested provide medical advice / evidence in respect to their suitability to attend the workplace;
  • Must fully comply with treatment plans provided by their medical practitioner;
  • Must fully comply with any reasonable requests from JCU which may include requests to attend medical examinations organised by JCU.

Table 3 provides guidance from Queensland Health regarding exclusion periods from the workplace.  There may be other instances that require exclusion from the work place based on the person’s role and infectious diseases other than those identified.

2.5.1   Staff and Students

To attend or visit JCU facilities, staff and students must comply with the guidance provided within Table 3 in addition to any other reasonable requests of JCU.

Any exclusion periods will also apply to children of staff and students that come to the workplace.

2.5.2   Contractors, Volunteers and Visitors

To attend or visit JCU facilities contractors, volunteers and visitors must abide by the guidance provided within Table 3 in addition to any other reasonable requests of JCU.

The exclusion period will also apply to children of visitors or volunteers that come to the workplace.

2.5.3   Table 3: Exclusion Periods for Contagious Disease

Condition

Exclusion of Case (person with infection)

Exclusion of Contacts 1 (persons not to be exposed to the person with the infection)

Chickenpox (varicella)

Exclude until all blisters have dried. This is usually at least 5 days after the rash first appeared in unimmunised people and less in immunised people.

Pregnant women and anyone with an immune deficiency (eg. leukaemia) or receiving chemotherapy or immunosuppressive therapy may require preventive immunoglobulin and/or exclusion for their own protection. Contact the local Public Health Unit for advice. Otherwise not excluded.

Cold sores (herpes simplex)

Exclude young children unable to comply with good hygiene practices while sores are weeping (sores should be covered with a dressing where possible).

Exclude young children unable to comply with good hygiene practices while sores are weeping (sores should be covered with a dressing where possible).

Conjunctivitis

Exclude until discharge from eyes has ceased unless non-infectious conjunctivitis.

Not excluded.

Cytomegalovirus (CMV)

Exclusion not necessary.

Not excluded.

Diarrhoea and/or Vomiting
(including amoebiasis, campylobacter, cryptosporidium, giardia, rotavirus, salmonella and viral gastroenteritis, but not norovirus or shigella - see separate section)

Exclude until there has not been a loose bowel motion for 24 hours;
Exclude staff whose work involves food handling until they have not had any diarrhoea or vomiting for 48 hours;
If there are more than 2 cases with loose bowel motions in the same centre or a single case in a food handler notify your nearest Public Health Unit.

Not excluded.

Diphtheria

Exclude according to Public Health Unit requirements.

Exclude according to Public Health Unit requirements.

Enterovirus 71 (EV71)
Neurological Disease

Written medical clearance is required confirming the virus is no longer present in the child’s bowel motions.

Not excluded.

Glandular fever (Epstein Barr virus (EBV), mononucleosis)

Exclusion not necessary.

Not excluded.

Haemophilus influenza type b (Hib)

Exclude until child has received appropriate antibiotic treatment for at least 4 days. Written medical clearance from doctor or public health unit is required to return to child care/school, confirming child is not infectious.

Not excluded.

Hand, foot and mouth disease

Exclude until all blisters have dried.

Not excluded.

Head lice

Exclusion is not necessary if effective treatment is commenced prior to the next attendance day (i.e. the child does not need to be sent home immediately if head lice are detected).

Not excluded.

Hepatitis A3

Exclude until at least 7 days after the onset of jaundice or illness. Written medical clearance from doctor or public health unit is required to return to child care/school, confirming child is not infectious.

Not excluded.

Hepatitis B

Exclusion not necessary.

Not excluded.

Hepatitis C

Exclusion not necessary.

Not excluded.

Human immunodeficiency virus (HIV/AIDS)

Exclusion not necessary.

Not excluded.

Influenza and influenza- like illness

Exclude until well.

Not excluded.

2.5.4   Placement

Every healthcare facility should have a written policy regarding infectious diseases and work restriction and exclusions. Staff and students will comply with the host organisations requirements.

2.5.5   Children

Staff and students with sick children must comply with Table 3.  A staff member and students may be requested to provide further medical advice from an appropriate, licensed medical practitioner for the specific case at hand. The costs of such medical advice must be borne by the staff member or student.

Supervisors must require staff to promptly remove a sick child from the workplace and utilise their leave entitlements. Supervisors must also require students to remove a sick child from the workplace.

See also the JCU Children in the Workplace and Study Environment Policy and related Procedures.

2.6     Pregnancy and Immunocompromised

Staff and students are to be informed of the need to disclose pregnancy or an immunosuppressed state (such as undergoing chemotherapy). This is to occur during on‑boarding of staff and students, or as soon as is known.

JCU staff and students who are pregnant/breastfeeding or will be / are immunosuppressed (such as undergoing chemotherapy) must inform their supervisor / course coordinator as soon as possible.

Following notification, an individualised risk assessment must be completed in order to identify potential risks / hazards, and where possible provide appropriate modifications to the work or study area in order to minimise health and safety risks during this time.  The risk assessment must be documented outside of the Riskware system and be kept confidential.

Regular reviews will need to be undertaken between the staff or student and their supervisor / course coordinator, to ensure that adjustments are made as pregnancy/treatment/condition progresses e.g. each trimester.  It is advisable to seek medical advice regarding the nature of the work or study undertaken to ensure safety whilst undertaking JCU activities.

Students who are enrolled in an accredited Course that has professional experience or practical classes must still meet the requirements of the course. For the avoidance of doubt, JCU may, in its absolute discretion, determine that a person cannot participate in a particular activity if the person is placed at increased disease risk due to pregnancy or immunosuppressed state.  JCU may choose to, but is not obligated to, seek independent medical advice in making its decision.

For staff who will be /are immunosuppressed the HSE Health Management Procedure states, where possible, JCU will accommodate medical restrictions, which will be assessed on a case-by-case basis. A suitable duties plan may necessary for those requiring workplace modifications.

For further assistance conducting the risk assessment or implementing the necessary workplace modifications, contact the Injury Prevention & Management Advisor in the Health, Safety & Environment unit.

In the event that a staff member is unable to complete tasks associated with their usual position, they are to refer to the JCU Enterprise Agreement - Transfer to a Safe Job, which provides for the temporary transfer of pregnant employees to a safe role should the need arise.

2.7     Health Screening

When working with human pathogens of risk group 3, health screening will be required.  This will consist of a combination of medical examination(s) and diagnostic testing. The required health screening required must be specified in the facility operation manual by the laboratory supervisor.

All records obtained by this process must be kept confidential.

2.8    Instance of Exposure to Infectious Disease

JCU conducts activities that have potential for exposure to blood-borne viruses or a zoonotic infection.  The following are examples that may occur:

Healthcare settings:

  • Injuries from sharp instruments contaminated with blood or body substances (e.g. needle stick injuries);
  • Splashes to mucous membranes from blood and body substances (e.g. splashes to mouth);
  • Splashes to non-intact skin from blood and body substances (e.g. cuts or abrasions).

Infectious disease research laboratories:

  • Injuries from all sharp instruments contaminated with blood or body substances (e.g. needle stick injuries);
  • Splashes to mucous membranes from blood and body substances (e.g. splashes to mouth);
  • Splashes to non-intact skin from blood and body substances (e.g. cuts or abrasions);
  • Exposure to aerosols.

Infected or suspected animal with zoonotic infection:

  • Bites from infected animals;
  • Exposure to aerosol;
  • Close contact with animal.

2.8.1   Placement

The policies and procedures for the host organisations must be followed when an incident occurs.

  • In Queensland Health care facilities it is expected that policies and procedures, consistent with the Queensland Health Guideline: Management of occupational exposure to blood and body fluids, 2017, are followed.  The steps include but are not limited to:
    • Immediate care of the person;
    • Incident reporting;
    • Risk assessment of the exposure to determine the follow up steps required:
      • Potential for blood-borne viruses;
      • Immediate, or follow up testing of the person exposed, and if applicable, the source of the potential infection; and
      • The need and suitability of any post exposure prophylaxis.
  • If the host is unable or unwilling to conduct the follow up testing required then the JCU course coordinator (or equivalent) will need to be notified by the student.  JCU will then arrange for the follow up testing or treatment to occur with assistance of the students’ GP or JCU Health (Townsville campus);
  • The Course Coordinator or Placement Coordinator must contact the student once aware of the incident to determine and offer further support services.

2.8.2   Exposure to Infectious Disease Teaching & Research at JCU Facilities

The following outlines the process to be followed where potential exposure to an infectious disease and / or a blood-borne virus has occurred at a JCU facility, or location under JCU control.

  • Immediate care of the exposed person:
    • Wash any open wounds, or skin sites with soap and water;
    • Remove any contaminated garments;
    • If relevant, irrigate mucous membranes and eyes (remove contact lenses) with water or saline solution for at least 30 seconds;
    • If material has entered the mouth, spit and rinse with water several times:
      • If water is not available non-water cleanser or antiseptic should be used.
    • Place contaminated items in clinical waste bin; and
    • If applicable segregate any animals suspected of having zoonotic infection risk (eg horse with Hendra);
    • Refer the exposed person for medical review.
  • Inform the supervisor of the incident as soon as possible;
  • Division staff to advise the HSE unit of the incident as soon as possible;
  • A risk assessment will need to be conducted to determine (amongst other things):
    • Potential for blood-borne viruses or other infectious diseases;
    • Whether immediate and / or  follow up testing of the person exposed is required and if applicable the source of the potential infection (for example: testing of the patient that a needle was initially used on):
      • Before and after the testing the subject should have the context of the exposure and results of the testing discussed with them by an appropriate licensed medical practitioner.
    • The suitability or need for any post exposure prophylaxis.
  • The investigation, risk assessment and any follow up screening for disease or infection must be retained by the HSE Injury Prevention and Management Advisor.

2.9    Infection Control

There are activities conducted at JCU that have potential for exposure to infectious diseases.  Systems in place and practices conducted by JCU must be compliant with the industry standards for infection control as listed in Table 4.

In relation to teaching and research, divisions must consult the WHS-PRO-009 Biosafety Procedure.  This Procedure outlines the requirements for biosafety applications.  Biosafety applications are required for both teaching and research activities that have potential for exposure to infectious diseases.

The University has a responsibility to provide (or ensure) training in infection control principles to staff, students and contractors prior to entering facilities.

2.9.1   Table 4 Infection Control Guidelines

Field

Guideline

Body

Healthcare

Australian Guidelines for the Prevention and Control of Infection in Healthcare

National Health and Medical Research Council

Dentistry:(in addition to Healthcare)

Guidelines for Infection Control (Third Edition)

Australian Dental Association

Research Laboratory:

(in addition to HSE-PRO-009)

AS/NZS 2243.3:2010 Safety in Laboratories Part 3: Microbiological safety and containment

Australian Standards

Veterinarian

Guidelines for Veterinary Personal Biosecurity 2017

Australian Veterinary Association

Healthcare

Guideline Management of Occupational Exposure to Blood and Body Fluids

Queensland Health

2.9.2   Infection Control Identified Facilities

The Divisions are required to identify facilities and disciplines that require infection control plans.  These facilities are required to have in place infection control plans consistent with their activities.  The infection control plans may form part of a laboratory or facility manual.

If facilities are deemed to require infection control plans this must be identified in the listing on the JCU website.  This information must be provided to the HSE unit before the start of Semester 1 each year.

Facilities that require infection control plans must also have the following requirements in place:

  • The facility must be constructed in line with Australian and other applicable laws and standards for the facility, ventilation, air conditioning, cooling towers and water systems;
  • Surface finishes that are easy to maintain and clean for the type of facility (including fixtures, fittings, and benches);
  • Adequate handwashing facilities;
  • Ability to isolate infectious patients (animal or human);
  • Separation of Procedure and cleaning areas;
  • Facilities for waste storage and processing;
  • Adequate storage for:
    • Waste streams;
    • Personal protective equipment;
    • Patient care and operational supplies.

2.9.3   Infection Control Plan

Where it is identified that an infection control plan is required for operation of a facility or activities conducted by the Division the following matters should be considered for inclusion in the relevant plan:

  • Identification of potential infectious diseases for the facility/activity;
  • Standard precautions:
    • Hand hygiene;
    • Entry exit Procedures;
    • Personal protective equipment required during tasks and Procedures:
      • Autoclaving of laboratory or other protective gowns before washing;
      • Cleaning of personal protective equipment (PPE) between use;
      • Cleaning schedule of the facility (based on the infection guidelines for that type of facility);
      • Identification of cleaning products;
      • Approved disinfectants;
      • Cleaning:
        • ¨ Frequency;
        • ¨ Treatment of reusable clothing and items.
    • Waste treatment and disposal:
      • Clinical waste;
      • Sharps.
    • Sterilisation Procedures required for either single use or reusable items;
    • Vaccination required for the facility;
    • Special Procedures if infectious disease risk is identified;
    • Regular pest inspections and controls in place;
    • Cleaning and maintenance requirements for the facility;
    • Procedures to clean up infectious materials (such as blood).

2.9.4   General Infection Control

JCU has in place basic infection control precautions consisting of handwashing, cleaning, and waste disposal in various locations throughout campuses and sites. This includes:

  • Handwashing:
    • Hand washing facilities are to be in place;
    • A supply of soap or/hand wash is to be available;
    • Paper towel or hand dryers are to be in place;
    • A bin is to be in the location for all discarded paper towel;
    • If hand washing facilities are not available, then a suitable alcohol based hand rub will need to be supplied.  This will consist of 60 – 80% alcohol.  Example would be a supply provided on a field trip.
  • Toilets will be maintained in good working order with hand washing facilities:
    • Sanitary waste disposal receptacles will be in place and a contract maintained for regular disposal.
  • Cleaning:
    • Cleaning of general facility;
      • Toilets and bathrooms:
        • Daily cleaning of floors, sinks, toilets and door handles.

2.9.5   Spills Management (Non Clinical, Non Laboratory)

General spills of blood and bodily substances are covered under this section of the Procedure.

The basic principles include:

  • The spill is to be dealt with as soon as reasonably practicable;
  • Isolate or restrict the area;
  • Contact the Estate Directorate as soon as reasonably practicable to arrange a cleaner to attend the location;
  • Assume all blood and bodily fluids are infectious;
  • Bleach or another approved disinfectant will be used on the location;
    • Carpets or porous surfaces may require further cleaning.

2.9.6   Sharps found on Campus (Non-Clinical, Non-Laboratory)

Sharps can be found on JCU properties.  In these instances the Estate Directorate must immediately be contacted to arrange for removal of the item.  The campus contacts for removal of sharps can be found in on the JCU website.

Personnel are to be trained in the safe work Procedure for removal of sharps.

The sharps removal process includes the following:

  • Move people from the vicinity;
  • Wear disposable latex or vinyl gloves;
  • Take a sharps container to the location of the sharp;
  • Place the container on the ground;
  • Handle one sharp at a time, preferably by forceps;
  • Keep the sharp end pointing away from you;
  • Seal the sharps container;
  • Remove gloves and place these into a plastic bag and dispose of in general waste;
  • Dispose of the sharps container in a clinical waste bin.

3      Sharps and Clinical Waste

The definition and disposal path of sharps and clinical waste is addressed in WHS-009-Biosafety Procedure.

3.1     Notifiable Disease Reporting

When identified a notifiable disease is required by law to be notified to government agencies.  The typical context of identifying a notifiable disease at JCU may include:

  • During laboratory analysis where a notifiable disease may be identified within a sample (for example: pathology test is positive for Tuberculosis);
  • An animal has been confirmed by pathology testing to have a notifiable disease (for example: a horse tests positive for Hendra) after displaying symptoms;
  • A staff member or student attends a medical facility and is diagnosed with a notifiable disease.

When undertaking analysis of biological samples, when the diagnostic method has the potential of identifying notifiable diseases (as in the testing method is capable of such results).   The laboratory must be familiar with the listing of notifiable disease relevant for the testing being undertaken.  Within Australia there are different requirements for notifiable disease(s).  Depending on the analysis conducted, review the relevant notifiable disease reporting as in Table 5.

3.1.1   Table 5: Notifiable Disease Governing Body

 

Governing Body

Notifiable Human Disease

The Health Department of each state or territory of Australia maintains lists of notifiable conditions and the required reporting.

Notifiable Animal Disease

The Department of Agriculture and Water Resources, maintains a list of notifiable animal diseases and the notifying requirements.

Each state of Australia will also have further requirements that can be searched.

Notifiable Plant Disease

Each state or territory government agency maintains a list of notifiable plant pest and diseases, in Queensland this is the Department of Agriculture and Fisheries.

The laboratory will need to outline processes for the reporting of notifiable disease(s).  This will need to include:

  • Where conducting diagnostic testing (for example bulk processing of samples such as a pathology laboratory, or water quality laboratory) a process for notification to the governing agency and to the laboratory supervisor;
  • In the case of a research laboratory where there is the possibility to identify a notifiable disease, be aware of the relevant notifiable diseases and have processes in place to:
    • On identification of the notifiable disease notify the supervisor;
    • Section 5.12 of this Procedure will apply to ensuring the situation is appropriately managed;
    • Material within the laboratory may need to be quarantined until contact is made with the governing body.
  • Where the project aims to take samples of notifiable disease(s) the legalities of the sample collection and processing will need to be discussed with the governing body to determine any arrangements that may need to be entered into.

Non laboratory identification of a notifiable disease may occur due to:

  • An animal at JCU presenting with a notifiable disease;
  • A student or staff member being diagnosed with a notifiable disease.

In these instances see 2.12 of this Procedure as the situation has potential to become a critical incident.

3.2    Outbreak Investigation & Management & Notifiable Disease

This does not include the detection of a notifiable disease in an external pathology setting. As part of standard external pathology and other diagnostic laboratory reporting systems, external laboratories will undertake notifications to appropriate authorities in accordance with industry standards and procedures.

This section of the Procedure is in regard to identification of a notifiable disease in an uncontained setting at JCU, or if there is a suspected or confirmed outbreak (or potential for loss of containment) of a notifiable disease at JCU, the following roles must be notified with as much information is known:

  • Relevant supervisor;
  • Divisional Executive Officer;
  • JCU HSE unit;
  • The Critical Incident Coordinator (Chief of Staff - CoS).

Initial containment and response will be undertaken as required depending on the nature of the potential or actual outbreak and facilitated by the HSE Unit, Critical Incident Coordinator and Division. Once it is identified that a notifiable disease outbreak has occurred within a JCU laboratory or setting, JCU will undertake notification to the appropriate authorities as identified at Table 6 and in accordance with industry standards and procedures.

Once a notifiable disease is reported there is potential that government agencies will take over the management of the site. JCU will provide access and resources as directed.  Any internal or regulatory investigation and response will depend on the type of outbreak and circumstances.

Further guidance on responding to a potential or actual outbreak is provided below in Table 6.

  1. Table 6: Notifiable Disease Response Guidance

Step

Suggested Approach

Responsibilities (dependent on facility and type of outbreak)

Containment:

  • Determine existence of the notifiable   disease potential or actual outbreak.
  • Determine risk level of   incident.
  • Determine controls required.

Determine if a notifiable disease is suspected or confirmed;

Consultation with relevant expertise (medical, microbiological, veterinarian);

Determine if further action is required by JCU;

Gather information regarding those potentially exposed.

College and Divisional management to determine if the outbreak may escalate;

The Critical Incident Coordinator (CoS) notified;

Contact HSE unit if notifiable disease is suspected or confirmed.

Determine control measures that are needed and respond

Implement standard infection control Procedures;

Quarantine of people, animals or facility;

Immediate cleaning or treatment of a facility;

Communication with relevant stakeholders;

Fumigation.

Critical Incident Coordinator (CoS) to determine extent of critical incident response;

College and Divisional management to assist government agencies with requests.

Notify and communicate (may occur during either containment or response)

In consultation with the HSE unit, Critical Incident Coordinator ensures contact with relevant government departments as required

 

4      Related Documents, Legislation and Other Resources

4.1 Related Legislation, Codes of Practice and Standards

Legislation

  • Public   Health Act 2005 (Qld)

Standards

  • AS/NZS   2243.3:2010 Safety in Laboratories Part 3: Microbiological safety and   containment

Codes of Practice

 

Guide

  • The   Australian Immunisation handbook 10th Edition,
  • Guidelines   for Infection Control, 3rd Edition, Australian Dental Association,   2015
  • Australian   Guidelines for the Prevention and Control of Infection in Healthcare,   Australian Commission on Safety and Quality in health Care, 2010
  • Guidelines   for Veterinary Personal Biosecurity 2017, Australian Veterinary Association
  • Guideline   Management of Occupational Exposure to Blood and Body Fluids 2017, Queensland   Health

4.2 Related Documents and Other Resources

Procedure

HSE-PRO-009: Biosafety Procedure

HSE-PRO-020 Children in the Workplace and Study Environment Procedure

HSE-PRO-022 Children in the Workplace and Study Environment Field Trip Procedure

HSE-PRO-007 Field Trip Procedure

Documents

University Course Immunisation List

Facility Immunisation List and Infection Control Plan

Other than Teaching Staff Immunisation Requirements

Placement Immunisation Requirements

Courses and Roles that Require Infectious Disease Screening

Campus Contact for Sharps and Body Fluids (non laboratory, non clinical)

5      Administration

NOTE:  Printed copies of this procedure are uncontrolled, and currency can only be assured at the time of printing.

Approval Details

Procedure Sponsor

Deputy Vice Chancellor, Services & Resources

Version no

19-1

Date for next Major Review

 

Revision History

Version

Approval date

Implementation date

Details

Author

19-1

02/09/2019

11/09/2019

Procedure established

Biological, Radiation and Chemicals Safety Advisor

Contact person

Biological, Radiation and Chemicals Safety Advisor

Keywords

Infection control, infectious diseases, notifiable diseases, immunisation, health screening, placements, acute infections, medical exclusion, exposure to infectious diseases, sharps, blood borne virus